Glitch in the (Medicare) matrix

3 minute read

A spate of practices were hit by unusual delays in Medicare payments, just days after the switch from PKI to PRODA.

Data security certificates change. Days later, Medicare payment batches, which normally take a day to return to practices, start taking up to seven days instead.

Coincidence? It’s hard to tell.

Practice manager Riwka Hagen, founder and admin of popular Facebook group Practice Managers Network, said posts from multiple clinics about the strange delay in Medicare payments started last Thursday.

“Many practices were experiencing holdups with their Medicare payments – they were issuing payment requests to Medicare via their normal billing processes and those batches [of payments] were just simply not being processed,” Ms Hagen told The Medical Republic.

“What that means is that practices ended up having to wait much longer than they counted on to actually get paid.”

Earlier that week, on Sunday 13 March, was the deadline for practices to update e-credentialling processes, the much-anticipated switch from PKI certificates to PRODA.

Ruminations on tax structures aside, on a day-to-day level the move to PRODA basically changed the way practices transmit data to Services Australia.

This includes making Medicare claims and accessing the many online services in HPOS. 

PRODA is an online authentication system that Services Australia is starting to use to verify the identity of users who want to access important government online services.  

That alone made it a stressful week for medical clinics.

“Practices were very stressed about having to update security certificates, because it’s quite a process,” Ms Hagen said.

“They needed to have their HPOS up to date, and it was a multi-step process to go through in order to update those certificates.”

There was some chat among practice managers on Facebook as to whether the two could be related.

Services Australia told TMR that it was aware of a recent system issue affecting some Medicare claims, that has since been resolved.

“Health providers may also be experiencing issues if they have not yet transitioned to web services technology or renewed their PKI certificates which expired on 13 March,” a Services Australia spokesperson said.

“The transition to web services is not a sudden change and we have been working closely with industry on this for a number of years.”

It apologised for the inconvenience and encouraged affected practices to resubmit any claims that haven’t been processed.

Ms Hagen said that, while medical clinic managers were reporting that their outstanding claims had now come through, there was a residual sense of confusion and conflicting stories.

“What we’re hearing is that Medicare was indicating to practices when they were calling that part of the reason for the slow processing was to do with Medicare staff being relocated to cover flood relief in NSW and Queensland,” she said.

“And that’s come through a few from a few of our members.”

Responding to these claims, Services Australia denied that this was the case.

“This was not related to our support for Australians impacted by the floods in Queensland and Northern NSW,” the spokesperson said.

“We are well equipped to deploy staff where they’re needed, which has seen us deliver a record number of disaster payments to communities while maintaining our essential business-as-usual services.”

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